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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200848
Report Date: 09/10/2025
Date Signed: 09/10/2025 11:20:21 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/09/2025 and conducted by Evaluator Patricia Manalo
COMPLAINT CONTROL NUMBER: 15-AS-20250909112710
FACILITY NAME:FREMONT RTRMT COM-HAPPY LVNG BY COGIR/COGIR FREMONFACILITY NUMBER:
019200848
ADMINISTRATOR:HUSAIN, SARAHFACILITY TYPE:
740
ADDRESS:2860 COUNTRY DRIVETELEPHONE:
(510) 790-1645
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:40CENSUS: 39DATE:
09/10/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Sarah Husain, Assistant Executive Director TIME COMPLETED:
11:35 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do ensure that facility is maintained free of smoke
Staff do not provide a comfortable environment for resident
Staff inappropriately spoke to resident
Staff do not communicate with resident regarding care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 09/10/2025 at 9:15AM, Licensing Program Analyst (LPA) P.Manalo arrived unannounced to conduct a complaint investigation and deliver findings on the above allegations. LPA met with Assistant Executive Director, Sarah Husain and explained the purpose of the visit. Executive Director, Salvador Gomez, arrived shortly after.

During the course of investigation, LPA interviewed staff and witness. LPA obtained and reviewed independent living resident roster, assisted living resident roster, staff roster, LIC500, independent living Admission Agreement, and visitor log dated 08/27/2025 to 09/10/2025. Based on interview and record review, LPA confirmed R1 lives in the independent living.

We have found that the complaint was UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report provided.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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